Extremity Rehab after Axillary Dissection

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J - 18 Feb 2005 11:03 GMT

http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Breast/Physiotherapy/de
fault.htm

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A. P. Thorsen - 18 Feb 2005 21:59 GMT

> http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Breast/Physiotherapy/de
fault.htm

Oooooo! I nearly swoon with joy . . . this is the first time I've seen
an example of actual evidence-based guidelines relating to lymph node
removal and lymphedema avoidance. Thanks, J -- seems there really is
basis for hope that common practice is improving!

Ann T.
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Mary Fisher - 18 Feb 2005 22:33 GMT

>> http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Breast/Physiotherapy/de
fault.htm
>>
> Oooooo! I nearly swoon with joy . . . this is the first time I've seen an
> example of actual evidence-based guidelines relating to lymph node removal
> and lymphedema avoidance. Thanks, J -- seems there really is basis for
> hope that common practice is improving!

You surprise me. In 1998 ALL the women in my breast care ward, no matter
what surgery they'd had, were made to do lots of exercises, especially the
"Upper Extremity Rehabilitation". I was warned that I'd have to do
'agressive' exercises by my surgeon well before I had the surgery. It began
the day after surgeryand it hurt but I'm glad we did it. We were given
leaflets describing the stretching exercises and encouraged to contine after
we got home. I did, I don't know how many of the others did.

Hand and Arm Care instruction was given by the breast care nurses, including
simple massage and skin care as well as warnings about a wide variety of
injurious practices.

This was in UK though and I was in hospital for eight days, which was
wonderful. The trend now is to free beds very quickly, I'm not sure that's
good for everyone. The opportunity for enforced rest and reuperation as well
as the training about how to lead our new lives was invaluable.

Mary

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A. P. Thorsen - 23 Feb 2005 22:05 GMT

>>>http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Breast/Physiotherapy/de
fault.htm
>>
[quoted text clipped - 6 lines]
> what surgery they'd had, were made to do lots of exercises, especially the
> "Upper Extremity Rehabilitation".

Yeah, I had exercises'n'such, too -- mostly stretching-type things, but
some fairly intense.

I think I wasn't clear: The "swoon" was because this was the first time
I'd seen guidelines for lymphedema prevention that relied on checking
and referencing actual research evidence (limited though it *certainly*
is), rather than just rehashing one of those folkloric "Old Doctor's
Tale" lists that seem to show up everywhere ("don't lift more than 15
pounds", etc.). The rehab per se wasn't what made me react.

I'm sure other practices have done similarly, but the "rehash old
ill-founded nonsense" approach is sooooo much more common.

Makes more sense, I hope?

Ann T.
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Mary Fisher - 23 Feb 2005 22:35 GMT

<snip>

> I think I wasn't clear: The "swoon" was because this was the first time
> I'd seen guidelines for lymphedema prevention that relied on checking and
> referencing actual research evidence (limited though it *certainly* is),
> rather than just rehashing one of those folkloric "Old Doctor's Tale"
> lists that seem to show up everywhere ("don't lift more than 15 pounds",
> etc.). The rehab per se wasn't what made me react.

Ah, I see, sorry, I misunderstood!

> I'm sure other practices have done similarly, but the "rehash old
> ill-founded nonsense" approach is sooooo much more common.

In bc as in many other conditions! You should see the stuff on the epilepsy
ng, we have a lot of laughs :-)

> Makes more sense, I hope?

Yup.

Thanks for clearing it up though. I do jump to the wrong conclusions at
times, it has been said (by me) that I only open my mouth to change feet ...

Mary

> Ann T.
> Remove 'dontsendspam' from address to reply by email

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Guess Who - 18 Feb 2005 22:43 GMT

Unfortunately, this is not evidence based research..if you check the
references they are papers not case controlled studies.
The Dana Farber has an outgoing evidence based study ongoing. I researched
this topic awhile back and it's an open area of research. But I agree this
is the first document which tries to put it all together.

>> http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Breast/Physiotherapy/de
fault.htm
>>
[quoted text clipped - 5 lines]
> Ann T.
> Remove 'dontsendspam' from address to reply by email

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J - 23 Feb 2005 21:50 GMT

> Unfortunately, this is not evidence based research..if you check the
> references they are papers not case controlled studies.
> The Dana Farber has an outgoing evidence based study ongoing. I researched
> this topic awhile back and it's an open area of research. But I agree this
> is the first document which tries to put it all together.

They are guidelines for all professionals (and subsequentally their patients) in one Province
(British Columbia, Canada).
Seems to be a "working formula". I've not seen any poster here from BC mention lymphedema.
J

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Guess Who - 24 Feb 2005 01:45 GMT

To be evidence based, which is the new hot term in medicine and nursing, the
article did not meet this criteria to be deemed evidence based....the
trouble is lymphedema practice has no hard science just word of mouth to
back it up. When I read this web page, I thought they capture this concept
well.

>> Unfortunately, this is not evidence based research..if you check the
>> references they are papers not case controlled studies.
[quoted text clipped - 10 lines]
> mention lymphedema.
> J

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